Acne: An Unwelcome Glow of Pregnancy

One of my daughters lives in a condo complex with lots of pregnant and recently pregnant women. You would think the conversation around the pool would be all about babies and breastfeeding. But according to my daughter, one of the most frequent topics is all about acne.

For many women, pregnancy can be a trip back to high school for the skin. The reason is a rise in the male hormone androgen. Yes, women do make male hormones. Male hormones may be converted to female hormones. Your body will make more male hormones during puberty and during pregnancy, especially during your last trimester1,2.

What Can You Do?

You probably know that many acne medications need to be avoided during pregnancy. The worst of these are the oral acne medications called retinoic acids. Accutane is one you may have used or heard about. These drugs can cause birth defects and need to be avoided. But the good news is that there are safer effective treatments for acne during pregnancy and breastfeeding1,3.

The first thing you can do is go back to treating your skin as you did in high school:4

Wash your skin twice per day with a mild cleanser in lukewarm water. Avoid cleansers that have scrubbing beads because they can cause more inflammation.

Protect your skin from the sun. Use a sunscreen with an SPF of at least 30. This will also cut down on the development of darkened areas of skin usually on the forehead and around the eyes that can occur during pregnancy (called melasma).

Wash your hair every day and keep your hair away from your face.

Don’t use cosmetics that are oil-based.

Don’t pick or squeeze.

The next step is a topical acne medication. Now it’s time to get your health care provider involved. You might want to add a dermatologist to your pregnancy care team. Topical acne medications that can be used safely during pregnancy include azeleic acid and glycolic acid1,3.

Glycolic acid is available over the counter. You need a script for azeleic acid. Azeleic acid may have an added benefit of improving melasma. Always check with your health care provider before taking any over-the-counter treatment1,4.

Your health care provider may prescribe a topical antibiotic. These topical antibiotics are FDA pregnancy category B, which means they are generally considered safe for use in pregnancy: 1

Erythromycin

Clindamycin

Metronidazole

If none of these treatments are working, there are some oral medication you can take. These include the antibiotics azithromycin, cephalexin, and erythromycin. At this point it would be a good idea to be working with a dermatologist who is familiar with treating acne during pregnancy1.

Don’t assume that because you’re pregnant, you have to live with acne. Your body is going through a lot of changes, acne doesn’t help. Acne may also continue after delivery and could contribute to post-partum “baby blues.” If acne is taking away some of the joy of pregnancy, talk to your health care provider1.

Dr. Chris Iliades is a medical doctor with 20 years of experience in clinical medicine and clinical research. Chris has been a full time medical writer and journalist since 2004. His byline appears in over 1,000 articles online including EverydayHealth, The Clinical Advisor, and Healthgrades. He has also written for print media including Cruising World Magazine, MD News, and The Johns Hopkins Children's Center Magazine. Chris lives with his wife and close to his three children and four grandchildren in the Boston area.